Acute renal failure in community-acquired bacteraemia

Over a 1-year period, 239 patients with community-acquired bacteraemia in positive blood culture were prospectively evaluated to establish the prevalence and outcome of acute renal failure (ARF). Fifty-eight patients (24%) were identified as having ARF defined by a doubling or more in serum creatinine. The overall mortality in this group was 53% compared with 22% for patients with bacteraemia but without ARF (p less than 0.001). Within the ARF group there were two identifiable subgroups. Thirty patients had resolution of renal failure with treatment of the bacteraemia, and only 6 (20%) of these died. Of the remaining 28 where ARF persisted, 25 (89%) died (p less than 0.000001). Nine patients were dialysed, and only 2 survived. The majority of the remaining 24 patients died of overwhelming bacteraemia before dialysis was indicated. ARF is a common finding in community-acquired bacteraemia, and this has a poor prognosis particularly in those without early resolution of renal failure.